Delicious Do's (and don'ts)

High-fiber, whole-grain, soy or no soy, green tea? It seems like nearly every day, there's a new study making different claims about the foods women need – or should avoid – to protect against breast cancer. How is it possible to make sense out of all the competing information? Experts agree that task can be a challenge. "It can be very confusing to understand the many claims that are made about diet and breast cancer risk," says Mary Holland, a registered dietician and certified specialist in oncology with Presbyterian Cancer Center. Ami Desai, oncology outpatient dietitian at Charlotte’s Batte Cancer Center, agrees. Many of the breast cancer patients she sees are confused by a lot of self-researched information. Some claims have been backed up by scientific research and some have not, Holland says. And even those supported by research may change because new studies are being done all the time and may conflict with previous findings. "We try to emphasize that balance and moderation usually prevail,” she says, "and to try not to rely on any one food or nutrient by getting a good variety of foods, especially from plant sources."Chef Carrie Leonard, herself a renal cell carcinoma survivor, says healthy diet and lifestyle can help provide insurance – but not a guarantee. Leonard, a chef instructor with Johnson & Wales University for more than 17 years, also cautions people to watch out for print and media advertisements that look like actual articles about cancer prevention, as they have a commercially ulterior motive. Charlotte registered dietician Megan Hovis has worked with women recovering from breast cancer in her practice and has also seen many studies claiming that certain foods are either "good" or "bad" for cancer patients. "It is important to consider the source before adopting it into your meal plan," she says. At Presbyterian, Holland works with cancer survivors and educates patients on healthy eating, cancer prevention, treatment side effect management and optimal nutrition during or after treatment. She’s had breast cancer patients ask about general topics such as eating healthier and losing weight, but also about cancer prevention and supposedly cancer-curing diets or supplements that they may have read about. "Specifically, I get questions about phytochemicals, soy products (benefits and negative effects), foods containing Omega 3 fatty acids and supplements." But there’s no simple answer. "Based on research, we know that there are some correlations with breast cancer risk and diet and lifestyle," Holland says. "There is a strong correlation with alcohol intake and breast cancer risk. Therefore, the recommendation is no more than one drink per day for women and two drinks per day for men. There is evidence that suggests that a high-fat diet, being overweight or obese and physical inactivity all contribute to an increased risk of breast cancer in postmenopausal women." So that means patients shouldn’t stop with dietary modifications alone. Hovis advises her clients on the importance of regular exercise, recommending women get an hour of moderate activity per day. That may include walking, running, swimming, tennis or calisthenics. She also urges women to maintain good bone mass by combining cardio with weight-bearing activity at least twice a week. "As we age," she says, "our bone mass decreases and it is imperative we keep our bones healthy." Desai also counsels on the importance of physical activity. “There are suggestible links between increased physical activity and lower rates of cancer,” she says. “Increasing your physical activity helps you to maintain energy balance, (and) decreases fat accumulation and insulin resistance, thus giving you many health benefits.” For those asking about preventing breast cancer, both Holland and Hovis advise a diet plentiful in whole grains, colorful vegetables and fruits, and a moderate amount of lean proteins and healthy fats. "The more color in the fruits and vegetables, the more nutrients (like antioxidants, flavonoids and carotenoids)," Hovis says.Leonard, for her part, urges people to try unusual fruits and look for recipes with unfamiliar vegetables. “I vary the categories of foods I consume in order to fit all the puzzle pieces into a complete nutrition profile,” she says. For clients who have been diagnosed with breast cancer, Hovis encourages an even wider variety of fruits and vegetables. "I have them add dark leafy greens (like spinach or kale), lots of broccoli, sweet potatoes, carrots, tomatoes, nuts and many other nutrient-dense foods. I also encourage tea," she says. What about soy? Studies about whether it poses a breast cancer risk have been conflicting, Holland says. Some suggest soy could be protective against breast cancer, but more evidence is needed to make that claim. “Soy is a good source of protein and other nutrients,” she says, “so we feel that soy foods like tofu, edamame and soy milk can be part of a healthy diet and provide some benefits.” Desai cautions that if someone is on hormone replacement therapy or has estrogen-receptor-positive breast cancer, then she suggests avoiding soy supplements. Holland, Desai and Hovis say that if you’re looking for more information on diet and breast cancer prevention, it’s best to consult with a registered dietician or go to reliable sources like the American Cancer Society, the American Institute for Cancer Research, the National Cancer Institute or the American Dietetic Association. Adds Leonard: “An interesting tidbit I learned in a seminar at UNC is that we all have cancer cells floating around in us. All we can do is assist our bodies in the fight to keep them from ganging up on us by eating and living healthfully.” So, when boiled down to its essentials, the advice is actully simple. “Eating healthy and incorporating at least moderate exercise,” she says, “will always be in style and reliable.”

Good health guidelinesMary Holland, a registered dietician and certified specialist in oncology, has the following dietary recommendations for her patients asking about cancer prevention and recurrence:

1. Eat at least five servings of fruits and vegetables a day.2. Choose whole grains and limit simple sugars.3. Choose lean meats and try to incorporate more plant sources of protein like beans, lentils or quinoa.4. Limit red meat and avoid processed meats.5. Choose good fats like olive oil, canola oil, nuts, avocado and fish, and be sure to include a source of Omega 3 fats a few times a week (such as fish, walnuts, canola oil or flax)6. Exercise five or more days a week7. Try to aim for and maintain a healthy weight

In a saucepan bring 2 cups water to a boil. Toast uncooked quinoa with a teaspoon of olive oil in another saucepan or sauté pan for two minutes over medium-low heat. Add quinoa to the boiling water and add a pinch of salt. Reduce heat to low, cover and simmer for 15 minutes. Allow quinoa to cool to room temperature; fluff with a fork. In a large bowl, combine Greek yogurt, olive oil, sea salt, black pepper lemon juice and vinegar and mix. Toss in shrimp, diced tomatoes, cucumber, bell pepper, green onion, mint and cilantro.Stir in cooled quinoa. Enjoy at room temperature or chill for later.